Article 5 Section 8 Miscellaneous Special Programs Table of Contents TITLE MPG CITE Introduction 050801 Pickle Benefits Restricted Benefits and the Repatriate Program 050802 Tuberculosis Dialysis and TPN Special Treatment Benefits 050803 Unmarried Pregnant Women Under 21 Income Disregard 050804 Special Programs MediCal to Healthy Families Bridging Program for Access for Infants and Mothers AIM Linked Infants 050805 Healthy Families to MediCal Presumptive Eligibility HFPE Program 050806 Refugee Medical Assistance RMA and Entrant Medical Assistance EMA 050807 Iraqi and Afghan Special Immigrants SI 050808 Organ Transplant AntiRejection Medications Program OTAM 050809 Trafficking and Crime Victims Assistance Program TCVAP 050810 Refugee Document Identification Chart APPENDIX A Victim of Trafficking Certification for Adults APPENDIX B Victim of Trafficking Letter for Children Under 18 APPENDIX C Refugee Entry Date Documentation Chart APPENDIX D Special Immigrant Documentation Immigration Status and Date of Entry APPENDIX E Bridging Q A APPENDIX F Special Indicator Instructions for OTAM APPENDIX G Processing Guidelines RESOURCE TITLE BENDS HF Transition to MediCal BENDS CR 6086 050801 Introduction General This section describes the miscellaneous special MediCal programs and applicable individual limitations regarding MediCal eligibility 050802 Pickle Benefits Restricted Benefits and the Repatriate Program A 20 Social Security Increase Pickle Benefits Persons who quality for MediCal under this category were MEM discontinued from SSISSP after April 1977 currently receive RSDI benefits and would be eligible to SSISSP benefits if their RSDI COLA increases received after SSISSP discontinued were disregarded The activities in PICKLE cases are handled by specialists in FRCs according to the regulations addressed in MPG Article 5 Section 10 B Restricted benefits provide medical coverage for emergency and Restricted pregnancyrelated services only Certain IRCA and OBRA aliens are Benefits eligible to restricted benefits MPG Article 7 Section 3 explains alien status C Repatriate Program The Repatriate Program is a cash assistance program available to MEM 50255 US citizens who have established residence in a foreign country and wish to return to reside in the United States Persons eligible for cash payments and other assistance under the Repatriate Program are not eligible for MediCal until they are discontinued from the Repatriate Program 050803 Tuberculosis TB Dialysis and Total Parenteral Nutrition TPN Special Treatment Benefits A Tuberculosis The TB program allows clinics and providers who serve TB infected persons to assist such persons in applying for MediCal This is an alternative to the applicant applying directly at an FRC These MEM PROC 5N providers may help applicants complete all initial MediCal forms used in the application process and may gather applicant verification The information will then be forwarded to the county welfare department for a MediCal determination MPG Article 5 Section 17 explains TB program benefits and details the eligibility determination B Dialysis and Total Parenteral Special MediCal benefits are available to eligible persons in need of dialysis or TPN services These benefits are explained in MPG Article 17 Section 1 MEM 50264 Nutrition TPN Special Treatment Benefits County of San Diego Health and Human Services Agency HHSA Program Guide Unmarried Pregnant Women Under Age 21 Income Disregard Number Page 050804 5 of 36 Effective Date 07182017 Background In April 2017 the Department of Healthcare Services DHCS informed counties that effective 812016 a new Income Disregard Program was created for unmarried pregnant women who are under the age of 21 There is no determination of income required for individuals who meet the eligibility criteria for this group Policy This program provides full scope or pregnancy related MediCal to those who do not qualify for any no cost mandatory or optional categorically needy coverage To be eligible the unmarried pregnant woman under 21 must either a live with her parents and not plan to file taxes or b be claimed as a tax dependent by her parents in the taxable year Procedure There will be no income determination for these individuals who will be identified automatically in the CalHEERS system The system will assign an M7 aid code to those who have satisfactory immigration status and an M8 aid code to those who do not Note Beneficiaries of this program who are under 19 years old are eligible for Continuous Eligibility for Children CEC Program Impacts MediCal References ACWDL 1706 Sunset Date This policy will be reviewed for continuance on or by 07312020 050805 MediCal to Healthy Families HFP Bridging Program Bridging A General ACWDL Children born to mothers in the Access for Infants and Mothers AIM program are deemed eligible to HFP for one year If they are AIM eligible at their one year redetermination they can remain HFP eligible until age 2 HFP will continue to serve AIM linked infants with income above 250 of the Federal Poverty Level FPL and below 300 FPL AIM linked children found ineligible to TLICP due to income exceeding 250 must be bridged to HFP MPG LTR 771 1212 ACWDL B To determine if a child is AIM linked workers must 1233 Eligibility Requirements Step Action 1 Clear INQ1 and INQ2 and look for aid code 0C in the last twelve months If the 0C aid code Then applies to the infant Go to Step 2 does not apply to the infant process as outlined in When to Complete Redetermination 2 Complete MediCal redetermination If the income is Then up to 250 of the FPL grant TLICP at or above 250 to 300 of the FPL go to Step 3 3 Bridge to the HFP MPG LTR 771 1212 C When a child is found eligible for bridging workers must ACWDL 1233 StepbyStep Bridging Instructions Step Action 1 Discontinue TLICP with timely notice 2 Grant aid code 7X for the month following the discontinuance of TLICP CalWIN will not trigger the CEC aid code refer to BENDS CR6086 for override instructions 3 Refer child to HFP using form MC 363 The following information will be attached to the MC 363 D Prior Period Bridging Case identifying information such as county worker name and phone number case name and case number and household members including the parents step parents and all children including step children and unborn s MediCal denial reason Reason and type of referral Individual Information including last name first name SSN CIN gender date of birth relationship individual gross income type of income allowable deductions and SOC amount if assessed Comments to describe any unusual situation to assist HFP in making the correct determination A copy of the most recent application or RV form if available A copy of the most recent MediCal NOA showing the income calculation for the MFBU with the SOC amount HF does not accept the Sneede NOA as income verification A copy of the most recent discontinuance NOA with the reason the child has been determined ineligible for zero SOC MediCal A copy of any proof of income dated within 45 days A copy of the current MFBU budget worksheet HF can use the MFBU budget computation worksheet as supporting income documentation Workers must print a copy of the CalWIN display SOCFinancial eligibility determination window that displays the budget that moved the child from zero SOC to a SOC A photocopy of the following documents if they are in the case file Birth Certificate if the childs US citizenship was validated through a birth record match in MEDS please indicate such on the MC 363 Immigration verification or Proof of Acceptable Citizenship or Identity documents DHCS 0011 Proof of tribal affiliation American Indian or Alaska Native The underlying principle of referring applications to HFP is to provide a seamless process to refer a child from MediCal to HFP MPG LTR 771 1212 There may be instances when a childs fullscope SOC eligibility in a ACWDL 0703 prior month based on the application is reduced to zero SOC ie fair hearing or the County recognizes it failed to act timely on a report of reduced income The worker will take their usual action to reduce the SOC for that month If zero SOC eligibility in the prior month is followed by a SOC in the following month the worker must determine whether Bridging is appropriate If Bridging is appropriate the worker must grant Bridging for that first SOC month The worker must then determine whether it is appropriate to refer the child to HFP in the current month E There is no consent requirement to bridge AIM linked children to HFP ACWDL Consent Requirement MPG LTR 771 1212 050806 Healthy Families to MediCal Presumptive Eligibility HFPE Program A General HFPE extends zero SOC coverage until a worker completes a MediCal eligibility determination when at Annual Eligibility Review AER all or some of the family are no longer eligible to HF and appear eligible for zero SOC MediCal based on income screening This program replaced the Healthy Families to MediCal Bridging program effective 7108 ACWDL 0818 B Aid Code HFPE uses Aid Code 5E for children whose responsible adult consented to have their AER form forwarded to MediCal for a determination ACWDL 0818 C Eligibility Determination Upon determining that a child is potentially eligible for MediCal without ACWDL 0818 a SOC HF will convert the childs eligibility to 5E and forward the familys latest AER along with all supporting documents to the appropriate county for a MediCal determination Since the AER serves as a MediCal application 5E eligibility will continue until a MediCal determination is made The worker must use the HFPE start date as the application date for MediCal This date is on the HF Administrative Vendor Detail Transmittal Form HFFM80 under the AE Start Date column HFPE will continue until the worker completes the eligibility determination ACWDL 0818 D Worker Actions If the child is Then Eligible to MediCal Activate with appropriate aid type Not eligible to MediCal Deny case send appropriate denial notices and check MEDS to ensure that the 5E AC discontinued E Evidence of citizenship and identity must be provided when ongoing ACWDL 0818 Citizenship MediCal eligibility is determined unless the individual falls within one and Identity of the exemption groups identified in MPG Article 7 Section 2 Verification Requirements County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Refugee Medical Assistance RMA and Entrant Medical Assistance EMA Number Page 050807 1 of 3 Issue Date 1232014 Effective Date Upon receipt Background RMA and EMA are forms of humanitarian resettlement assistance that enable refugees without linkage to MediCal to obtain health coverage The RMAEMA aid code is 02 Policy 050807 A Eligibility Requirements To be eligible to RMAEMA refugees must be determined ineligible to any other MediCal program including CalWORKs related MediCal MAGI or SSISSP Refugees determined to have no linkage to MediCal must be evaluated for RMAEMA If any member of the family is eligible to a MediCal program they must be placed in that program rather than RMA Families can have some individuals in RMAEMA and others in MediCal programs Citizen children of refugees are potentially eligible to RMAEMA benefits if they are determined ineligible to MediCal Fulltime students in an institution of higher education are ineligible for RMAEMA unless it is part of an employability plan developed by a county welfare department or its designee or is part of a plan for an unaccompanied minor The refugee must provide the name of their resettlement agency to the worker Applicants must meet the federal definition of refugee or entrant and provide proof of status from one of the following o Conditional Entrant o Refugee or Asylee o Permanent Resident Status for those who are now permanent residents who were formerly one of the other categories listed here o Amerasian o CubanHaitian Entrants o Victim of Severe Trafficking See Appendix A for a list of appropriate documentation A secondary SAVE verification is not required for refugees Otherwise eligible refugees with income below 200 of FPL are eligible to Zero SOC MediCal and those with income over 200 of FPL are eligible to RMA with a SOC For RMA workers must only evaluate incomeresources belonging to a refugee at the time of signing the SAWS1 application Increases after the SAWS1 date will not be counted County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Refugee Medical Assistance RMA and Entrant Medical Assistance EMA Number Page 050807 2 of 3 during the 8 month period A decrease in income or property will be applied and the budget recalculated The following is not counted in the RMAEMA income eligibility determination o Refugee Cash Assistance RCA o Inkind services provided by a sponsor or resettlement agency o Resources remaining in the refugees county of origin o Sponsors income or resources o Income earned after the date of application Refugee applicants can spenddown if over the property limits B RMA and Advanced Premium Tax Credits APTC Refugees with income above 138 of FPL ineligible to MAGI MediCal M1 aid code and below 200 are potentially eligible to zero SOC MediCal and Advanced Premium tax credits simultaneously and must be offered the opportunity to either enroll in APTC or continue with zero SOC MediCal for their eightmonth RMAEMA period C Time Limits RMAEMA is time limited to the shorter of The refugees first eight months of US residency beginning with the month of entry The asylees first eight months of asylum beginning with the month asylum is granted The entrants first eight months of parole release from USCIS custody The time period that DHCS determines there is funding available The time limit begins with the month of entry even if the refugee enters on the last day of the month RMAEMA benefits continue until the end of the 8 month eligibility period without redetermination or a change in benefits D Refugee Cash Assistance Refugees continue to receive RMAEMA through their eightmonth eligibility period if they are discontinued from RCA for any reason E Ongoing MediCal Evaluation Redetermination for ongoing MediCal must be completed prior to the end of the eightmonth time limit and discontinuation of RMAEMA See the RMAEMA Processing guide link for redetermination procedures Refugees with a diagnosis of Tuberculosis TB may be evaluated for TB MediCal if they have no other linkage at the end of their eightmonth eligibility period F Refugees Claiming Disability County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Refugee Medical Assistance RMA and Entrant Medical Assistance EMA Number Page 050807 3 of 3 Refugees who claim disability at application must have a DDSD determination If disability is established during the eightmonth RMAEM eligibility period the refugee must be placed in the appropriate disability based aid code if otherwise eligible RMAEMA beneficiaries who claim disability at the end of their eligibility period are not eligible for MediCal benefits a Pending Disability Determination G Victims of Trafficking Definition Sex trafficking in which a commercial sex act is induced by force fraud or coercion or in which the person induced to perform such act has not attained 18 years of age or The recruitment harboring transportation provision or obtaining of a person for labor or services through the use of force fraud or coercion for the purpose of subjection to involuntary servitude or slavery to repay a debt Adults and children identified as victims of severe forms of trafficking and family members of the victims are entitled to be treated as refugees for the receipt of RMAEMA benefits See the RMAEMA Processing Guide for required actions including reporting requirements for victims of trafficking H Sponsored Aliens Those identified as refugees asylees Victims of a Severe Form of Trafficking or a CubanHaitian Entrant are exempt from sponsored alien regulations References MEPM PROC 24A MEPM PROC 24B MEPM LTR 285 ACWDL 0946 ACWDL 9415 ACWDL 0149 ACWDL 0834 ACWDL 0503 ACWDL 1416 Sunset Date This policy will be reviewed for continuance by 1232017 050808 Iraqi and Afghan Special Immigrants SIs A General The National Defense Authorization Act of 2008 granted SI status to certain displaced noncitizens their spouses and children from Iraq and Afghanistan who were employed by or assisted the US Armed Forces These individuals may be eligible to receive a maximum of six months Afghan or eight months Iraqi of federal time limited RMA ACWDL 0853 Under a new federal law as of March 11 2009 the period of RMA eligibility for Afghan SIs has been extended to eight months Eligibility for Afghan SIs that are currently on RMA and still within this new eightmonth time limit must have RMA eligibility extended to cover the eightmonth time limit if they are otherwise eligibility ACWDL 0943 Afghan SIs who lost RMA eligibility in March 2009 or later based solely on the sixmonth time limit must have eligibility restored with proper notice if otherwise eligibility to assure that they are provided with eightmonths of RMA eligibility Afghan SIs who lost eligibility prior to March 2009 based solely on the previous sixmonth RMA time limit are not eligible for additional RMA coverage The worker shall ensure that these new requirements are met If Then The Afghan Sis applied after March 11 2009 Allow eightmonth time limit for RMA eligibility The Afghan Sis is currently RMA and still within this new eightmonth time limit Extend cover to eightmonth time limit Afghan Sis who lost RMA eligibility in March or later based solely on the sixmonth limit Restored eligibility with proper notice to assure that they are provided with eightmonth time limit of RMA Afghan Sis who lost eligibility prior to March 2009 based solely on the previous sixmonth RMA limit Do nothing they are not eligible for additional RMA coverage Iraqi and Afghan Sis both have the eligibility terms equal to those of standard RMA cases Workers shall use the DNCS 7111 Approval notice and the DNCS 7100 discontinuance notice The DHCS Afghan RMA restoration notice shall be used for Afghan Sis who lost eligibility based solely on the sixmonth time limit in or after March 2009 MPG LTR NO 695 1009 B Iraqi and Afghan SIs must meet all RMA eligibility requirements in ACWDL Eligibility MPG 050807B Requirements MPG LTR NO 670 0309 C Period of Eligibility Date of Entry ACWDL Afghan Special Immigrants 0853 For Afghan SIs and their eligible family members who establish their SI status prior to arriving in the US their eligibility period begins on the date admitted to the US Date of Entry For Afghans and their eligible family members who establish their SI domestically from some other immigration status their eligibility period begins on the date in which LPR status was granted In no circumstances will additional services be provided for the months of eligibility that occurred prior to the effective date of law December 26 2007 or prior to application for RMA benefits Iraqi Special Immigrants For Iraqi SIs and their eligible family members who establish their SI status prior to arriving in the US the eightmonth eligibility period begins on the date admitted to the US Date of Entry For Iraqis and their eligible family members who establish their SI domestically from some other immigration status the eightmonth eligibility period begins on the date in which LPR status was granted In no circumstances will additional services be provided for the months of eligibility that occurred prior to the effective date of law December 26 2007 or prior to application for RMA benefits MPG LTR NO 670 0309 D The following chart illustrates time limits of eligibility for Afghan and ACWDL Time Limit Iraqi SIs Examples Months of MediCal Eligibility for Afghan and Iraqi SIs Months of Possible Eligibility Date of Entry Date of Application Eligibility Ends of Benefit Months Afghan SI 6 months September 1 2008 September 1 2008 February 28 2009 6 months Afghan SI 6 months September 1 2008 November 1 2008 February 28 2009 4 months Afghan SI 8 months March 1 2009 May 1 2009 October 31 2009 6 months Afghan SI 8 months March 1 2009 March 1 2009 October 31 2009 8 months Iraqi SI 8 months March 1 2009 March 1 2009 October 31 2009 8 months Iraqi SI 8 months March 1 2009 April 1 2009 October 31 2009 7 months ACWDL MPG LTR NO 695 1009 E Documentation The worker must determine eligibility in accordance with current RMA eligibility requirements The worker will confirm the SIs immigration status and date of entry through verification of documentation Refer to Appendix D for a complete list of acceptable documentation ACWDL 0853 MPG LTR NO 670 0309 F Income Resources Iraqi and Afghan SI eligibility shall be determined using the same RMA income and resource requirements in MPG 050807E MPG LTR NO 670 0309 ACWDL 0853 G Aid Code Coding Requirements ACWDL Aid Code 0853 Iraqi and Afghan SIs will be aided under Aid Code 02 Coding Requirements The worker must ensure all Iraqi and Afghan SI beneficiaries have the proper coding in CalWIN USCIS entry date Date of Entry or date LPR status granted Alien registration number Country of origin Refugee Special Indicators a Afghan AfghanSIV b Iraqi Iraqi SIV MPG LTR NO 670 0309 H A redetermination of eligibility is required prior to the end of the sixor ACWDL Ongoing eightmonth time limit and discontinuance of RMA This MediCal redetermination must comply with federal regulations which require Evaluation that the beneficiary continue to receive MediCal until the determination of ongoing benefits is completed The redetermination shall include the following procedures The worker must send a discontinuance of RMA notice of action and an MC 210 SOF to the RMA beneficiary no later than 60 days before the end of the sixor eightmonth eligibility period Request additional information from the beneficiary regarding changes in income property medical condition disability status or household composition RMA beneficiaries are not required to resubmit information they have already provided if that information has not changed The beneficiary will continue to receive MediCal until the redetermination is completed If the redetermination is not complete by the end of the sixor eightmonth time limit benefits will be continued under the appropriate Medically Indigent Aid Code until complete RMA beneficiaries who claim disability status at any time during the sixor eightmonth time limit will be required to complete a DDSD evaluation The beneficiary is entitled to continuing MediCal benefits according to MPG Special Notice 0112 Item 3F while the DDSD evaluation is being completed The worker must document the result of the redetermination in the case narrative Timely notice of action must be mailed out prior to discontinuance of benefits NOTE Under no circumstances is RMA eligibility for Iraqi and Afghan SIs to continue beyond the sixor eightmonth federal time limit MPG LTR NO 670 0309 050809 Organ Transplant AntiRejection Medications OTAM A Introduction Assembly Bill 2352 added section 1413270 to the Welfare and Institutions Code to enable MediCal beneficiaries to remain eligible to receive MediCal coverage for antirejection medication for up to two years following an organ transplant Without antirejection medications the body can potentially reject the transplant and the beneficiary may require a new transplant have deterioration in their health require hospitalization dialysis or possibly die ACWDL 1102 MPG LTR 732 611 B In order to be eligible for the program a beneficiary must ACWDL 1102 Eligibility Have had an organ transplant within two years and Be discontinued or about to be discontinued from MediCal or MediCal based California Childrens Services CCS and Not have Medicare or private health insurance that covers organ transplant antirejection medications Or Have had an organ transplant within two years and Be eligible for restricted MediCal only and Not have CCS based MediCal and Not have Medicare or private health insurance that covers the organ transplant antirejection medications There are no other verification requirements such as income resources residency citizenship or identity It is not necessary to verify who paid for the organ transplant for eligibility to this program NOTE There is potential for a beneficiary to be eligible to this program more than once For each organ transplant they would be eligible for up to two years from the date of their most recent transplant MPG LTR 732 611 C Beneficiaries can be referred to the program in the following ways ACWDL Referral Source Answering yes to the following question on the MC210 RV Has any family member living in the home received an organ transplant Through a list provided by DHCS Client request through ACCESS or in the FRC MPG LTR 732 611 D Required actions when a client has been referred to the program ACWDL 1102 Referral Actions Step Action 1 Flag the case as a possible OTAM program case using the CalWIN Special Indicator MC Organ Transplant see Appendix G for instructions NOTE It is crucial to flag these cases with a special indicator so that the county can ensure that potentially eligible beneficiaries are evaluated for OTAM when they lose fullscope MediCal eligibility 2 If the client is referred by the Then DHCS list and the transplant date is listed Accept this as proof of the transplant date Enter information into case comments DHCS list and no transplant date is listed their answer on the MC 210 RV or the beneficiary contacts the County Request a letter on physicians letterhead from the treating physician with the National Provider Identifier NPI The letter must state that the individual had an organ transplant and the date of that transplant Scan letter into case file and note in case comments MPG LTR 732 611 E ACWDL Eligibility In order to process individuals referred to the Organ Transplant AntiProcess Rejection Medication Program workers must Step Action 1 Complete SB87 process and determine that the individual is not eligible to any other fullscope MediCal program If Then Eligible to another fullscope program Approve individual for that program Not eligible to any fullscope MediCal program Continue with the evaluation 2 Question beneficiary about private health insurance Investigate available resources in case file and MEDS for indications that they may have private insurance If the beneficiary Then Does not have private insurance Continue with the eligibility determination Does have private insurance Verify that it does not pay for antirejection medication If the insurance does pay for antirejection medication do not grant OTAM Verification of Health Insurance can be any of the following Summary of benefits showing antirejection medications are not a covered benefit Letter from the insurance stating that antirejection medications are not covered Documentation showing that the transplant and or any benefits related to the transplant are in a period of exclusion Documentation showing the beneficiary has exhausted his or her lifetime limit on all benefits under the plan Documentation showing his or her yearly benefits for treatment of the organ transplant has been exhausted Any other documentation from the insurance company that states that antirejection medications are not covered 3 Document insurance verification in case file 4 Obtain date of organ transplant from Drs letterhead or DHCS list NOTE Workers must allow applicants sufficient time to provide verification that their insurance does not cover antirejection medication and verification of the organ transplant date The OTAM applicant must remain active in their previous aid code during the OTAM application process If the applicants MediCal case is closing and good cause is established for providing verification workers must complete an override to keep the applicant on their previous aid code while the applicant provides verifications for the OTAM program 5 Have MEDS clerk enter eligibility in MEDS with a beginning date on the 1st of the month of termination from full scope Medical and a termination date two years from the date of the transplant Example 1 Beneficiary had an organ transplant 112010 Beneficiary found eligible to program 312011 Termination date is 12312012 Example 2 Beneficiary had an organ transplant 412009 Beneficiary found eligible to program 312011 Termination date is 3312011 6 Send approval notice if applicable MPG LTR 732 611 F Notice of Action Approval Notice ACWDL MC 378 APPROVAL FOR ORGAN TRANSPLANT AND ANTIREJECTION MEDICATION PROGRAM Discontinuance Notice MC 379 DISCONTINUANCE FOR ORGAN TRANSPLANT ANTI REJECTION MEDICATION PROGRAM Denial Notice There is no denial notice for this program If the individual does not cooperate or is not eligible their MediCal case remains closed MPG LTR 732 611 G Redeterminati on There is no required annual redetermination for this program ACWDL 1102 However if a client reports a change in circumstances related to this program they must be reevaluated for the program andor for MediCal Examples of relevant changes would be Any change that would make the beneficiary eligible to a fullscope MediCal program Obtaining Medicare or other private insurance that covers antirejection medications MPG LTR 732 611 H Alerts There are two alerts that will generate when OHC is obtained by the OTAM beneficiary ACWDL 1102 Medicare Alert ALERT 9061 MEDICARE ELIGIBLE COUNTY AID CODE TERMINATION NEEDED URGENT Other Health Coverage Alert ALERT 9062 POSITIVE OHC REPORTED COUNTY AID REEVALUATION NEEDED URGENT Workers must contact the OTAM beneficiary and determine if their health care covers antirejection medications Workers must close the OTAM case if the antirejection medications are covered MPG LTR 732 611 I Aid Code The Aid Code for this program is 77 This provides Stateonly ACWDL restricted scope MediCal coverage with no SOC for organ transplant antirejection medication for up to two years following an organ transplant to individuals who lost regular full scope MediCal or on restricted scope MediCal Aid Code 77 does not cover physicians office visits Aid code 77 will show on the Secondary screens in MEDS If the beneficiary already has a secondary aid code a ticket must be opened by the MEDS helpdesk at the state level MPG LTR 732 611 J There is no retroactive coverage for this program unless the county Retroactive fails to act on the notification of possible OTAM eligibility When an Coverage individual with a closed MediCal case contacts the county If the Then the worker former beneficiary requests coverage and the county has not been notified prior to case closure of the organ transplant must evaluate the individual for the program with the day of request as the beginning date of aid for OTAM former beneficiary did inform the county of the possible OTAM eligibility prior to case closing via MC210 RV or the county received notification from DHCS and failed to evaluate the client Worker must evaluate the individual for the program with the first of the month following the case closure as the beginning date of aid MPG LTR 732 611 County of San Diego Health and Human Services Agency HHSA Program Guide Trafficking and Crime Victims Assistance Program TCVAP Number Page 050810 1 of 3 Background Senate Bill SB 1569 effective January 2007 ensures that specified noncitizen victims of human trafficking domestic violence or other serious crimes that meet MediCal or Refugee Medical Assistance RMA eligibility requirements but not Satisfactory Immigration Status SIS can receive statefunded full scope MediCal Policy TCVAP covers noncitizen victims of human trafficking domestic violence and other serious crimes whose lack of SIS makes them ineligible to federal refugee programs but whom meet all other requirements for MediCal or RMA The statefunded MediCal and RMA eligibility categories created by SB 1569 are limited to two types of noncitizen victims 1 Trafficking Victims Noncitizen victims of a severe form of trafficking in persons who have filed or are preparing to file for a T Visa or are taking steps to become certified by the US Department of Health and Human Services Office of Refugee Resettlement ORR Note Child victims of severe forms of trafficking do not require ORR certification to be eligible for benefits 2 Survivors of Domestic Violence and Other Serious Crimes Noncitizen victims who have filed for or have been granted a U Visa Procedure To establish eligibility for benefits under the TCVAP program an applicant must Meet all eligibility requirements not related to immigration status for a MediCal program available to refugees or for the RMA program and Meet the immigration status documentation requirements specific to TCVAP meaning they are a victim of trafficking domestic violence or other serious crime AND They have applied for a T Visa are preparing to apply or are taking steps to be certified by ORR They have applied or been granted a U Visa Note The term victim includes both the direct victim and certain family members called derivative relatives Derivative relatives are those who have appliedare preparing to apply for a T Visa or have filed a U Visa application These individuals are eligible as ORR only issues certification letters to the primary victim Documentation Requirements Trafficking 1 Police government agency or court records Status 2 News articles 3 Documentation from a social services trafficking or domestic violence program 4 Documentation from a legal clinical medical or other professional County of San Diego Health and Human Services Agency HHSA Program Guide Trafficking and Crime Victims Assistance Program TCVAP Number Page 050810 2 of 3 T Visa U Visa Application must have been filed from whom the applicant has sought assistance in dealing with the crime 5 A statement from any other individual with knowledge of the circumstances that provided the basis for the claim 6 Physical evidence such as a wheelchair bruises or cast 7 A copy of a completed visa application or written notice from the federal agency that they received it 1 A confirmation receipt letter from United States Citizenship and Immigration Services USCIS verifying and application has been filed 2 A copy of the T Visa application 3 Statements from officials who have assisted or are assisting the victim with a the application 1 A confirmation receiptletter from USCIS 2 Form I797 Approval Notice or I797C Extension of U status 3 U Visa stamp in passport Period of Eligibility For those who qualify under MediCal eligibility rules T Visa Applicants U Visa applicants One year unless an application for continued presence or a T Visa is filed within the first year of eligibility If an application is filed within this period eligibility is extended until the T Visa is granted or denied or until they are certified by ORR for federal eligibility Eligibility will continue unless the U Visa is administratively denied When TCVAP beneficiaries are granted a U Visa their TCVAP benefits will continue for the life of the visa or until their immigration status changes For those who qualify under RMA rules T Visa applicants U Visa applicants Eight months unless an application for continued presence or a T Visa is filed within the first eight months of eligibility If an application is filed within this period eligibility is extended until the T Visa is granted or denied or until they are certified by ORR for federal eligibility Eligibility will continue unless the U Visa is administratively denied When TCVAP beneficiaries are granted a U Visa their TCVAP benefits will continue for the life of the visa or until their immigration status changes Impacts Automation This program requires bottom line override in CalWIN to assign the aid code See Processing Guide 20 Trafficking and Crime victims Assistance Program TCVAP Forms and Document Capture No impact Other Programs Affected None County of San Diego Health and Human Services Agency HHSA Program Guide Trafficking and Crime Victims Assistance Program TCVAP Number Page 050810 3 of 3 Quality Control Effective with the January 2016 review month Quality Control will cite with the appropriate error any case that does not follow the TCVAP regulations Management Reporting No Impact References ACWDL1525 Sunset Date This policy will be reviewed for continuance on or by 11302018 Release Date 11162015 APPENDIX A REFUGEE DOCUMENT IDENTIFICATION CHART RMAEMA ELIGIBLE DEFINITION DOCUMENTATION REFUGEES Refugee An individual admitted under Section 207 of INA I94ArrivalDeparture Record Refugee or Asylee An individual paroled under Section 212d5 of INA I94 ArrivalDeparture Record Asylee An individual from any country who has been granted asylum under Section 208 of the INA Date of entry for all asyleesis the date asylum is granted I94 ArrivalDeparture Record with admission codes AS1 AS2 AS3 I94 with Visa 92 V92 Order of an Immigration Judge granting asylum or asylum approval letter from USCIS Conditional Entrant An individual admitted under Section 203a7 of INA I94 ArrivalDeparture Record Permanent Resident Status Person who previously held one of the statuses above and was admitted for permanent resident status I551 Alien Registration Receipt Card or I151 or Green Card Code of any of the following indicates once held above status AS6 AS7 AS8 CU6 CU7 IC6 IC7 M83 M93 R86 RE6 RE7 RE8 Y64 Amerasian Admitted under the Amerasian Homecoming Act Only Vietnamese Amerasians are eligible for RMA I94 with code AM1 AM2 AM3 I551 with AM1 AM2 AM3 AM6 AM7 AM8 Vietnamese Exit Visa Vietnamese Passport or US Passport if stamped AM1 AM2 AM3 Citizen Child Of Refugee Children born in the US of refugee parents or children born of a refugee and a US citizen living with the refugee parent Parents with I94 or I551 document with codes as shown above RMAEMA ELIGIBLE DEFINITION DOCUMENTATION VICTIMS OF TRAFFICKING Adult Victims of Severe Forms of Trafficking Sex trafficking involving a forced or coerced commercial sex act or the recruitment of a person for labor through the use of force for the purpose of subjection to involuntary slavery Certification issued by ORR Children Victims of Sex trafficking involving a Letter for children issued by ORR Severe Forms of commercial sex act forced by Trafficking Under a child under 18 or the 18 Years Old recruitment of a person under 18 for labor through the use of force for the purpose of subjections to involuntary slavery RMAEMA ELIGIBLE DEFINITION DOCUMENTATION REFUGEES CubanHaitian Entrant Program 1 Cuban or Haitian Nationals 2 Cuban or Haitian Nationals who are subject of exclusion or deportation proceedings unless a final order of deportation has been issued 3 Cuban or Haitian nationals who have an application for asylum pending with INS unless a final order of deportation or exclusion has been issued 4 Cuban or Haitian Nationals granted parole for Humanitarian reasons or in the Public Interest unless a final order of deportation or exclusion has been issued 5 Cuban or Haitian Nationals paroled into the U S from Guantanamo or Havana with special status under the Immigration laws for CubanHaitians 1 I94 with CubanHaitian Entrant Status Pending 2 I94 and notices or letters indicating ongoing deportation proceedings 3 I94 with notation Form I589 filed 4 I94 with the word Parole or a reference to Section 212d5 5 I94 with stamped notation Public Interest Parole per Presidential Policy dated October 14 1994 RMAEMA INELIGIBLE DEFINITION DOCUMENTATION REFUGEES Applicants for Not eligible until asylum has Asylum been granted under Section 212d5 or Section 208 of INA Humanitarian Parolee Person residing in US under color of law Paroled under 212d5 of INA I94 ArrivalDeparture RecordParole Edition Public Interest Person who has been I94 ArrivalDeparture Record Parolee rejected for refugee status Paroled under 212d5 of INA Parole Edition APPENDIX B VICTIMS OF TRAFFICKING CERTIFICATION FOR ADULTS APPENDIX C VICTIMS OF TRAFFICKING LETTER FOR CHILDREN UNDER 18 APPENDIX D REFUGEE ENTRY DATE DETERMINATION CHART Workers will determine Date of Entry for refugees asylees victims of ACWDL severe forms of trafficking and certain family members using the following documentation Refugees Not Indochinese RMAEMAELIGIBLE REFUGEES I94 under INA Sec 212d5 with notation Refugee I766 with code A04 I688B under INA Sec 274a12a4 I94 under INA Sec 207 with code RE1 RE2 RE3 RE4 RE5 I766 with code A03 I688B under INA 274a12a3 INS Form I571 DOCUMENTATION Indochinese Refugees I94 under INA Sec 212d5 with notation Refugee I94 under INA Sec 207 I551 with code IC6 IC7 CubanHaitian Entrants I94 with stamp showing CubanHaitian Entrant under INA Sec 212d5 I551 with code CH6 CubanHaitian Passport with INA Sec 212d5 with stamp date after 101080 I766 with code C11 I766 with code A04 I688B under INA Sec 274a12a4 I688B under INA Sec 274a12c11 INS Form I221 INS Form I862 INS Form I220A INS Form I122 INS Form I221S INS Form I589 stamped by Executive Office for Immigration Review EOIR EOIR26 I766 with code C10 I688B under INA Sec 274a12c10 Notice of Hearing date before Immigration Judge I766 with code C08 I688B under INA Sec 274a12c8 Amerasians I94 with code AM1 AM2 or AM3 I551 with code AM6 AM7 or AM8 Vietnamese Exit Visa with code AM1 AM2 or AM3 Vietnamese Passport with code AM1 AM2 or AM3 United States Passport with code AM1 AM2 or AM3 Form I551 with code RE6 RE7 RE8 RE9 AS6 AS7 AS8 CH6 HA6 HB6 GA6 GA7 or GA8 Foreign Passport with temporary I551 Stamp with code RE6 RE7 RE8 RE9 AS6 AS7 or AS8 VICTIMS OF SEVERE FORMS OF TRAFFICKING DOCUMENTATION Adult Victims of Severe Forms of Trafficking ORR Certificate Appendix B Child Victims of Severe ORR Letter Appendix C Forms of Trafficking Derivative T Visas with code T2 Family Members of Victims T3 T4 or T5 of Severe Forms of Passport Trafficking I94 I797Notice of Action of Approval of the Visa RMAEMAELIGIBLE ASYLEES DOCUMENTATION Asylees I94 under INA Sec 208 not KurdishIraqi I94 with code AS1 AS2 AS3 INS Form I571 I766 with code A05 I688B INA Sec 274a12a5 Order of Immigration Judge Granting Asylum under INA Sec 208 Asylum Approval Letter from INS Asylum Office Written Decision from Board of Immigration Appeals I551 with codes AS6 AS7 AS8 KurdishIraqi Asylees I94 under INA Sec 208 or 108a I94 or I551 with codes AS6 AS7 AS8 Medical Document Form 157 EAD Card with QF1Asylum Granted QTII and QTIII Paroled in the Public Interest 274a12a5 or 274c11 MPG LTR NO 670 0309 APPENDIX E SPECIAL IMMIGRANT SI DOCUMENTATION IMMIGRATION STATUS AND DATE OF ENTRY ACWDL The following documents confirm both immigration status and date of entry for Iraqi and Afghan Special Immigrants DOCUMENTS ACCEPTABLE for CONFIRMING IMMIGRATION STATUS and DATE OF ENTRY RMAELIGIBLE SI DOCUMENTATION Principal Applicant Iraqi or Afghan SI Status Established Prior to Arrival in the US Iraqi or Afghan Passport with an immigration stamp noting that the individual has been admitted under Immigrant Visa Category SI1 or SQ1 and one of the following DHS stamp or notation on passport or I94 showing Date of Entry Spouse of Principal Applicant Iraqi or Afghan SI in SI1 or SQ1 Category Iraqi or Afghan Passport with an immigration stamp noting that the individual has been admitted under Immigrant Visa Category SI2 or SQ2 and one of the following DHS stamp or notation on passport or I94 showing Date of Entry Unmarried Child Under 21 Years of Age of Iraqi or Afghan SI in SI1 or SQ1 Category Iraqi or Afghan Passport with an immigration stamp noting that the individual has been admitted under Immigrant Visa Category SI3 or SQ3 and one of the following DHS stamp or notation on passport or I94 showing Date of Entry Principal Applicant Iraqi or DHS Form I551 showing Iraqi or Afghan SI Principal Afghan nationality or Iraqi or Adjusting Status in the US Afghan passport with an immigrant visa code of SI6 or SQ6 Spouse of Principal Applicant Iraqi or Afghan SI in SI6 Category DHS Form I551 showing Iraqi or Afghan nationality or Iraqi or Afghan passport with an immigrant visa code of SI7 or SQ7 Unmarried Child Under 21 DHS Form I551 showing Iraqi or Years of Age of Iraqi or Afghan nationality or Iraqi or Afghan SI in SI6 Category Afghan passport with an immigrant visa code of SI9 or SQ9 MPG LTR NO 670 0309 APPENDIX F BRIDGING QUESTIONS AND ANSWERS Question 1 Performance Standard 3 provides that families who have not consented to sending the childs annual RV form to HF shall be sent a consent request Does the 3 rd Performance Standard preclude the worker from trying to call the family first instead of sending the consent form Response No If the worker makes contact with the beneficiary by phone the worker only needs to document that contact in the case To meet the performance standard the worker would have to have made the call within five working days of the SOC However if the worker is unsuccessful in reaching the beneficiary by phone the consent form TEMP 07297 still will have to be sent within five working days of the SOC determination Question 2 If the most recent application has a consent section relating to Bridging and the family does not consent is the worker still required to send the consent form TEMP 07297 Response Yes If consent was not given on the most recent application the worker must follow the requirements of any applicable performance standard to obtain consent Question 3 Is a child eligible for Bridging in the month the child turns 19 Response Yes If otherwise eligible such children are placed in Bridging in the month they turn age 19 but they are not included in Bridging performance standards nor are they referred to HF Question 4 Is a child eligible for Bridging who is already enrolled in the Healthy Families program if heshe meets all the Bridging requirements Response Yes The Bridging requirements do not specify that the child cannot already be enrolled in HF APPENDIX G SPECIAL INDICATOR INSTRUCTIONS FOR OTAM Actions In order to enter the special indicator for the OTAM program take the following actions on the Collect Case Special Indicators screen Step Action 1 Select MCOrgan Transplant from the Type of Special Indicator dropdown menu 2 Change the effective begin date to the date of transplant if known or the date of referral if unknown 3 Change the effective end date to a date two years from the effective begin date 4 Save changes and narrate in case comments MPG LTR 732 611